Functional Gait Impairments in Peripheral Neuropathy: An Age- and Gender-Matched Case-Control Study in Patients with Multiple Comorbidities
Holly D Shan, BS1, Umayr R Shaikh, MPH, MPH1, Christian X. Lava, MS1,2, Christopher M. Ply, BS1, Henry L Stanton, BS1, John R DiBello, MS1, Margaret E Greer, MS1, Karen K. Evans, MD3, Christopher E Attinger, MD3, John S. Steinberg, DPM3 and Jayson Atves, DPM3, 1Georgetown University School of Medicine, Washington, DC, 2MedStar Georgetown University Hospital, Washington, DC, 3Medstar Georgetown University Hospital, Washington, DC
INTRODUCTION
There is an intuitive relationship between peripheral neuropathy (PN) and impaired gait, however, this relationship has not been quantified in a large scale study nor within a patient population with multiple comorbidities. We aimed to elucidate objective gait parameters in peripheral neuropathy through an age-and-gender matched study.
METHODS
Adult patients presenting to a single tertiary wound care center who could safely ambulate unassisted and without pain, open wounds, and lower extremity surgery in the previous three months were offered participation. Patients used wearable sensors and completed a 120-second walk test and a 30-second Romberg (sway) test. We analyzed data provided from the Motility Lab software (Hamilton Thorne) using STATA VSN 17.0. Potential confounders were controlled for using multivariable logistic regression analyses including BMI, type 2 diabetes mellitus (DMII), chronic kidney disease (CKD). Patients were matched through age (±5 years) and gender through chart review after completing the gait study.
RESULTS
Of 264 patients who completed the test,190 patients with an age match of ±5 years were included, split evenly into groups of 95 by presence of PN. Patients with PN had higher BMIs (32.2 ± 8.1 vs. 29.6 ± 8.9, p=0.045) and higher rates of DMII (73.7% vs. 31.9%, P<0.001), CKD (25.2% vs.10.5%, p=0.008), and ESRD ( 0.00% vs. 7.37%, p=0.007). PN predicted slower gait speed (0.82 ± 0.77 vs.0.96 ± 0.23, p=<0.001) and cadence (97.36 ± 11.29 vs. 101.64 ± 9.53, p=0.008), lower single limb support (35.71 ± 2.53 vs. 37.08 ± 2.24, p=<0.001), longer step duration (0.64 ± 0.08 vs. 0.59 ± 0.06, p=0.009), and increased double limb support (28.81 ± 4.53 vs. 26.18 ± 6.13, p=0.002) and sway (0.79 ± 0.76 vs. 0.48 ± 0.57, p=0.003). Multivariate regression revealed PN decreased gait speed (β=-0.1, p=0.008), cadence (β= -4.5 ,p=0.025), and single limb support (β=-1.3 ,p=0.003). PN increased step duration (β=0.02 ,p=0.052) and double limb support (β= 2.9,p=0.001).
CONCLUSION
PN uniquely influences gait in patients even with multiple comorbidities, indicating the importance of addressing PN symptoms before negative sequelae develop. Plastic reconstructive surgeons should be cognizant of treating PN in vulnerable patients and consider utilizing gait analysis to improve PN screening.
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